Airway catheters (“ACs”) are widely used to facilitate extubation and re-intubation. These long, thin hollow tubes may be inserted through an endotracheal tube (“ETT”) before extubation to provide continuous airway access and serve as a guide, should re-intubation be necessary following a failed extubation. Oxygen can be provided by either insufflation or jet ventilation through the distal end of the catheter and its side ports. Thus, ACs can be used to ventilate the patient as well as afford the physician additional time to consider alternative airway management strategies. This practice has reduced the incidence of extubation complications, especially in at-risk patients with head and neck pathology or undergoing maxillofacial or neck surgery.
Despite these benefits, complications can arise when using ACs. Barotrauma resulting in pneumothorax has been a major concern when using jet ventilation with ACs. One study found 11% of patients suffered barotrauma from jet ventilation with ACs. Fifteen other case studies have reported pneumothorax, cardiac arrest and death when jet ventilation via ACs were applied. The cause of these complications is often the excessive driving pressure with jet ventilation (15 to 50 psi) and/or airway obstructions. Therefore, it has been suggested that minimizing intratracheal pressure and prolonging expiratory times can reduce the risk of pneumothorax. Furthermore, jet ventilation may not be readily available in an emergency case, especially in rural health care settings or intensive care units (“ICUs”). These limitations have led to doubts on the utility of jet ventilation through an AC.